Lecture 1 – psychological and neurobiological consequences of child
abuse
Empirical evidence: numerous findings that childhood abuse and neglect have
pervasive consequences for mental and physical health
1950s: already stated that a warm childhood is significant to forming later
relationships.
Maltreatment = abuse (mishandeling) and neglect (verwaarlozing)
Childhood maltreatment: any act of commission/omission by a parent or other
caregiver that results in harm, potential for harm, or threat of harm to a child.
Harm does not need to be intended.
Omission (neglect): failure to meet child’s needs
Physical neglect: not enough food, clothing
Emotional neglect: no warmth/care, no fulfilment of emotional needs
Denial of access to education.
Commission (intentional behavior): actively doing something harmful
Physical abuse: hit child
Emotional abuse: yell at child, make them feel worthless
Sexual abuse: rape/unwanted touching, etc.
Shaken Baby Syndrome: brain injury when a baby/young child is shaken
violently
Prevalence of childhood maltreatment: World Health Organisation
1. Emotional abuse
2. Physical abuse
3. Sexual abuse
4. Physical neglect
High comorbidity of abuse and neglect physically abused, often also emotional
abused
DSM V: classification system for psychological disorders based on standard
criteria. Focus on objective description, not much etiology (cause).
Psychological consequences of child maltreatment:
Internalizing (depression, anxiety) and externalizing (aggression,
addiction) problems
Personality disorders (BPD, anti-social)
Psychotic symptoms
Suicide & self-injury
Often earlier onset, more severe/chronic, harder to treat. Type of abuse/neglect is
less relevant.
Symptoms not bound to 1 disorder: can be multiple different
symptoms!!
Childhood maltreatment depression, agitated, flashbacks, low self-esteem,
sleeping problems, fear, dissociation, problems forming relationships, etc.
, Can take long-time for correct diagnosis
o Enhance recognition amongst psychologists/medical specialists
Comorbidity of disorders
o Importance to treat underlying trauma(s)
Improve treatment options
o Importance of understanding underlying mechanisms to develop
specific interventions
Psycho-social consequences
Interpersonal problems
Self-image
Re-victimization
Intergenerational transmission
Consequences of maltreatment can be a risk factor for abusive/neglectful
behavior (30% of maltreated cases perpetuate own child)
o If one has developed a depressive disorder because of own childhood
maltreatment, you can be less sensitive to own child which can lead to
neglecting your own child
Stresses the importance of timely preventing abuse itself, but also of its
consequences
o Pregnant woman who has suffered from child maltreated work on it
before the baby is born
Conclude:
Childhood abuse and neglect important transdiagnostic risk factors for
development of psychological problems
o Internalizing symptoms (depression & anxiety)
o Externalizing symptoms (drug & alcohol addiction, aggression)
Consequences of emotional abuse and neglect at least as pervasive as
physical or sexual abuse
o Depressed patients with history of maltreatment have more severe
problems (more chronic, suicidality, comorbidity, profit less from
treatment)
Increased threat sensitivity, decreasing responsivity to reward, deficits in
emotion recognition and understanding
Resilience: when a person has overcome traumatic experiences or was
able to process those
Socially supported relationships as a buffer for maltreatment
Lecture 2 – psychological consequences and methodology
Psychological disorders
o Childhood maltreatment is a transdiagnostic risk factor (symptoms
overlap with other disorders)
o Lots of comorbidity
o Higher risk for earlier onset and more severe symptoms (suicidality)
Intergenerational transmission (30% of abused cases perpetrate own
children)
Interpersonal problems
, o Negative self-image
o Attachment at younger and later age
o Social exclusion
o Re-victimization
Long-term consequences of child maltreatment
Possible underlying mechanisms:
A. Exposure outcome
B. Exposure mediator outcome
Who reports what?
Self vs informant
Parent vs child (perpetrator – victim)
Retrospective vs prospective
Subjective report vs observing
When measuring intergenerational transmission of maltreatment, it matters who
you ask to report for neglect it’s less clear (children might not notice what they
are missing)
Only transmission of abuse was found in all reports
Neglect only found through self-report
Human research methods:
Retrospective (what happened in the past)
Advantages: practical in the case of long-term consequences (in adults)
Disadvantages:
o Memory = erroneous (wrong)
o Potential ‘recall bias’: memory = negative when in a bad mood;
positive when in a good mood
o Consequences and abuse are assessed at same moment: causality
regarding cause and effect unclear
Prospective (longitudinal research: follow individuals)
Advantages:
o Temporal order abuse & consequences
o Objective identification of abuse
o No recall bias
o No selective inclusion based on outcomes
Disadvantages
o Selective inclusion based on exposure
o On-ethical without intervening in the situation
o Duration, costs
o Drop-out
Combination of both methods is best!
Maltreatment in childhood substantially increases risk of adult depression and
anxiety in prospective cohort studies/documented abuse
